Inspectors Rebuke King/Drew

Government health inspectors have delivered a harsh broadside to Martin Luther King Jr./Drew Medical Center, saying that its nurses shirk basic patient care, doctors allow known problems to fester and county officials provide poor oversight.

The findings, outlined Monday in a memo by Los Angeles County’s health chief to the Board of Supervisors, stem from the most far-reaching investigation of the hospital in years, extending well beyond its ongoing troubles with its physician training programs. If uncorrected, the violations could lead to the loss of federal funding, although such a move would be unusual.

Acting on behalf of the federal government, state inspectors delivered their preliminary findings to local health officials Friday after a four-day surprise visit. Their inspection was triggered by a state inquiry into the recent deaths of two King/Drew patients, both of whom deteriorated undetected despite being connected to cardiac monitors. The U.S. Centers for Medicare and Medicaid Services will issue a formal report on the latest review as early as next month.

With these findings, King/Drew is under attack by agencies from the local to the national levels. In recent months, an accrediting group stripped the county-owned hospital of its ability to train aspiring surgeons and radiologists, and recommended closing the neonatology training program. The loss of physician training programs is already a potentially crippling blow to a hospital that serves a largely minority and impoverished community.

“We have a mess on our hands, without a doubt,” said Supervisor Zev Yaroslavsky, who has been on the board nine years. “King/Drew has been a bottomless pit of problems that have in large measure been inadequately addressed. And now the cumulative effect of this decades-long neglect is that the whole institution is threatened.”

According to the memo prepared by health department Director Dr. Thomas Garthwaite, the inspectors found:

* Nurses are not meeting fundamental expectations for care -- showing a serious lack of attention to patients when they are first examined, while they are being treated at the hospital and specifically when they are in pain. They also are responsible for errors and omissions in patient records.

* Problems with patient care and physicians are identified but changes are not made.

* The hospital’s governing body, which is ultimately the Board of Supervisors, will probably be cited for its lack of oversight, which means it must come up with a plan of correction. The supervisors delegate their authority over health care to the health department director.

Previously, Garthwaite has defended the quality of care provided at King/Drew, saying that it was comparable to other county hospitals. But in an interview Monday, he said he could no longer provide that assurance.

“I certainly feel less comfortable saying anything about the quality of care until we get additional studies done, additional actions taken,” he said.

Garthwaite went on to say that the outside inspectors are looking into the death of another patient, this time because of a possible prescription drug error. He said he did not yet know the identity of the patient or the circumstances.

As a result of his uneasiness with the state of the hospital, Garthwaite said he continues to move new managers from the health department into all areas of King/Drew to find problems and fix them.

Under the current leadership, he said, “I couldn’t assure myself that the right decisions were being made and that people were taking accountability for their actions and for the quality of care,” he said.

Yaroslavsky said he also questions whether King/Drew patients receive comparable care to that delivered at other county hospitals.

“It’s a disaster when people are not being adequately cared for,” he said. “People who are taken to Martin Luther King deserve the same quality of care as when they are taking to L.A. County-USC [Medical Center].... That obviously has not been the case.”

Supervisor Yvonne Brathwaite Burke, who represents the district that includes the hospital, called the latest inspection “absolutely troubling.” She conceded that she and fellow supervisors bore some of the responsibility for not addressing the problems sooner and more aggressively.

“I think that we have dropped the ball in the sense that we have not demanded corrective action and immediate action as we’ve heard each one of these things,” she said.

She added, however, that she was hoping that “the board doesn’t take the position that we have to give up on King.”

Dr. Alfred Forrest, the hospital’s interim medical director, said the hospital will fix any problems identified by the inspectors. “Whatever their concerns are, we will address them. We have to,” he said.

While county officials do not yet know the details of last week’s inspection, a state report into the two deaths last summer found clear fault with the care delivered by nurses and other employees.

According to a report issued last month by the state Department of Health Services, nurses failed to notice over a 45-minute period that one patient’s heart had slowed and then stopped. Also, some nurses apparently had never been taught to use new bedside monitors and one nurse lied about performing crucial tests ordered by a doctor. After being questioned, that nurse never returned to the hospital and was fired.

In both patients’ cases, a technician assigned to watch a central monitor displaying patients’ vital signs was also given other duties. It is unclear if anyone was watching the monitor when the women needed emergency attention.

Yesenia Reyes, a critical-care nurse at King/Drew, defended the quality of the nursing staff and said the staff is trying to deliver “caring, compassionate and competent care to our culturally diverse community.”

Reyes said that nursing cuts, however, have at times hindered providing the best care. “At times we have to assist with basic care, do the bedpans and also give our medications.... We are working very hard.”

The problems at King/Drew are prompting health officials and county supervisors to question the hospital’s ability to serve its core community. Garthwaite said it may be time to cut back the number of specialty services offered at King/Drew in order to focus on basic medical care.

And Yaroslavsky said it may be time to reconsider whether the county should be contracting with Charles R. Drew University of Medicine and Science to run its doctor training programs at King/Drew.

“How long should the community wait when lives are hanging in the balance, literally hanging in the balance?” he asked.